Fillable Vital Record Request Form (Town of Acton, Massachusetts)

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Vital Record Request Form (Town of Acton, Massachusetts)

On average this form takes 6 minutes to complete

The Vital Record Request Form (Town of Acton, Massachusetts) form is 1 page long and contains:

  • 1 signature
  • 3 check-boxes
  • 20 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Town of Acton, Massachusetts

BROWSE TOWN OF ACTON, MASSACHUSETTS (MA) FORMS

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Acton Town Clerk • 472 Main Street, Acton, MA 01720 • clerk@actonma.gov • (978) 929-6620
OFFICE USE ONLY: IF NOT FAMILY MEMBER CHECK ID
DATE COMPLETED:_________________ BY:____________________ AMOUNT PAID_____________
Vital Record Request Form
CERTIFIED COPIES ARE $10.00 EACH. CHECK MUST BE MADE PAYABLE TO TOWN OF ACTON
Birth Number of copies requested: _______
Name on record: _______________________________________________________________
Date of Birth: ________________________ Place of Birth: _____________________________
Marriage Number of copies requested: _______
Names on record: ______________________________________________________________
______________________________________________________________
Date of Marriage: _______________________ Place of Marriage: _______________________
Death Number of copies requested: _______
Name on record: _______________________________________________________________
Date of Death: ______________________ Place of Death: _____________________________
R
equestor Name (Print): ___________________________________________
R
elationship to Above: ____________________________________________ ID MAY BE REQUIRED
P
hone number or email: __________________________________________
________________________________________ ____________________________
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Vital Record Request Form (Town of Acton, Massachusetts)

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Completed 11 February 2021

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